Deathbed instructions and the assessment of capacity: A practical perspective

The assessment of capacity in the context of wills and advance care planning is a challenging task for modern practitioners with the increase in mentally disabling conditions, such as acquired brain injury. This challenge is only heightened in the situation where the assessment occurs at the client’s deathbed as there are the added elements of urgency, and emotional upheaval at the impending death of a loved one. This situation poses a minefield of problems a legal practitioner should be aware of, involving not only the assessment process but also potential professional liability issues. This presentation will address the practical considerations a legal professional should take into account when in this situation. We will focus on two discrete situations and the issues arising from them: first, where there has been an acquired brain injury and legal capacity is in question; and second, where a spinal injury has occurred which does not affect capacity, rather results in the inability to use conventional forms of communication to communicate his/her instructions. We will examine these case studies with a view to proposing a best practice model for legal practitioners when assessing capacity in this context.

The Role of the Law in Communicating Patient Safety

This chapter considers the role of the law in communicating patient safety. Downie, Lahey, Ford, et al’s (2006) preventing, knowing and responding theoretical framework is adopted to classify the different elements of patient safety law. Rather than setting out all relevant patient safety laws in detail, this chapter highlights key legal strategies which are employed to: prevent the occurrence of patient safety incidents (preventing); support the discovery and open discussion of patient safety incidents when they do occur (knowing),; and guide responses after they occur (responding) (Downie, Lahey, Ford, et al 2006). The law is increasingly being invoked to facilitate open discussion of and communication surrounding patient safety. After highlighting some legal strategies used to communicate patient safety, two practice examples are presented. The practice examples highlight different aspects of patient safety law and are indicative of communication issues commonly faced in practice. The first practice example focuses on the role of the Ccoroner in communicating patient safety. This example highlights the investigative role of the law in relation to patient safety (knowing). It also showcases the preventing responding and preventing elements in respect of the significant number of communication errors that can occur in a multi-disciplinary, networked health system. The main focus of the second practice example is responding example illustrates how the law responds to health service providers’ and professionals’ miscommunication (and subsequent incidents) during treatment, however it also touches upon knowing and preventing.

Examining the profile and experiences of older sub-acute patients who present to public hospital emergency departments in South East Queensland: A mixed methods approach

There is a scarcity of research that informs Interface Health Service (IHS) development. This research applied a mixed methods approach to profile older emergency department patients and patterns of health service use and to explore their ED experiences in public hospital EDs in South-East Queensland. IHS was under-utilised by older people with complex co-morbidities. Lack of communication and need identification were factors that undermined the effectiveness of IHS in reaching this cohort which highlighted a need for change.

PW376 A pilot study of a post-discharge nurse-led, educational intervention on cardiac self-efficacy and anxiety in post-PCI patients

Introduction Hospitalisation for percutaneous coronary intervention (PCI) is often short, with limited nurse-teaching time and poor information absorption. Currently, patients are discharged home only to wait up to 4-8 weeks to commence a secondary prevention program and visit their cardiologist. This wait is an anxious time for patients and confidence or self-efficacy (SE) to self-manage may be low. Objectives To determine the effects of a nurse-led, educational intervention on participant SE and anxiety in the early post-discharge period. Methods A pilot study was undertaken as a randomised controlled clinical trial. Thirty-three participants were recruited, with n=13 randomised to the intervention group. A face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days post-discharge. Intervention group participants received standard post-discharge education, physical assessment, with a strong focus on the emotional impact of cardiovascular events and PCI. Early reiteration of post-discharge education was offered, along with health professional support with the aim to increase patients’ SE and to effectively manage their post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal activities was measured to gauge participants’ abilities to manage post-PCI after attending the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE would influence participant anxiety. Results There were some increases in mean CSE scores in the intervention group participants over time. Areas of increase included return to normal social activities and confidence to change diet. Although reductions were observed in mean state and trait anxiety scores in both groups, an overall larger reduction in intervention group participants was observed over time. Conclusion It is essential that patients are given the education, support, and skills to self-manage in the early post-discharge period so that they have greater SE and are less anxious. This study provides some initial evidence that nurse-led support and education during this period, particularly the first week following PCI, is beneficial and could be trialled using alternate modes of communication to support remote and rural PCI patients and extend to other cardiovascular patients.

The introduction of an Inter-professional learning unit: staff and student perspectives

Background The School of Clinical Sciences comprises a number of health disciplines including podiatry, paramedic science, pharmacy, medical imaging and radiation therapy. A new inter-professional unit was introduced in 2014, which covered key introductory learnings applicable for future health practitioners. This study examined teaching staff and student perspectives about their experience with the new unit for first year students. Methods Qualitative interviews with teaching staff (n=9) and focus group interviews with students (5 groups which ranged in size from 4-30) were conducted. Extensive notes were taken during the interviews Issues emerging from the interviews were identified and organised according to themes and subthemes. Results Four major themes were identified namely: Something new; To be or not to be that is the question; Advantages of the new unit; and Areas for improvement. Previous staff experience with inter-professional learning (IPL) had been ad-hoc, whereas the new unit brought together several disciplines in a planned and deliberate way. There was strong philosophical agreement about the value of IPL but some debate about the extent to which the unit provided IPL experience. The unit was seen as assisting students’ social and academic adjustment to university and provided opportunity for professional socialisation, exposure to macro and micro aspects of the Australian health care system and various types of communication. For podiatry students it was their first opportunity to formally meet and work with other podiatry students and moved their identity from ‘university student’ to ‘podiatry student’. Other positives included providing the opportunity for staff and students to interact at an early stage with the perceived benefit of reducing attrition. Areas for unit improvement included institutional arrangements, unit administration aspects and assessment. Conclusion The unit was seen as beneficial by staff and students however, students were more polarised in their views than staff. There was a tension between feeling apart of and learning about one's own profession and feeling apart of and learning about the roles of other health professionals in relation to patient care and the health care system.

Other Side of This Life : Death, Value, and Social Being in Thomas Pynchon's Fiction

This dissertation analyzes the interrelationship between death, the conditions of (wo)man s social being, and the notion of value as it emerges in the fiction of the American novelist Thomas Pynchon (1937 ). Pynchon s present work includes six novels V. (1963), The Crying of Lot 49 (1966), Gravity s Rainbow (1973), Vineland (1990), Mason & Dixon (1997), Against the Day (2006) and several short stories. Death constitues a central thematic in Pynchon s work, and it emerges through recurrent questions of mortality, suicide, mass destruction, sacrifice, afterlife, entropy, the relationship between the animate and the inanimate, and the limits of representation. In Pynchon, death is never a mere biological given (or event); it is always determined within a certain historical, cultural, and ideological context. Throughout his work, Pynchon questions the strict ontological separation of life and death by showing the relationship between this separation and social power. Conceptual divisions also reflect the relationship between society and its others, and death becomes that through which lines of social demarcation are articulated. Determined as a conceptual and social "other side", death in Pynchon forms a challenge to modern culture, and makes an unexpected return: the dead return to haunt the living, the inanimate and the animate fuse, and technoscientific attempts at overcoming and controlling death result in its re-emergence in mass destruction and ecological damage. The questioning of the ontological line also affects the structuration of Pynchon's prose, where the recurrent narrated and narrative desire to reach the limits of representation is openly associated with death. Textualized, death appears in Pynchon's writing as a sudden rupture within the textual functioning, when the "other side", that is, the bare materiality of the signifier is foregrounded. In this study, Pynchon s cultural criticism and his poetics come together, and I analyze the subversive role of death in his fiction through Jean Baudrillard s genealogy of the modern notion of death from L échange symbolique et la mort (1976). Baudrillard sees an intrinsic bond between the social repression of death in modernity and the emergence of modern political economy, and in his analysis economy and language appear as parallel systems for generating value (exchange value/ sign-value). For Baudrillard, the modern notion of death as negativity in relation to the positivity of life, and the fact that death cannot be given a proper meaning, betray an antagonistic relation between death and the notion of value. As a mode of negativity (that is, non-value), death becomes a moment of rupture in relation to value-based thinking in short, rationalism. Through this rupture emerges a form of thinking Baudrillard labels the symbolic, characterized by ambivalence and the subversion of conceptual opposites.

Across the Oceans : Development of Overseas Business Information Transmission, 1815-1875

Earlier studies have shown that the speed of information transmission developed radically during the 19th century. The fast development was mainly due to the change from sailing ships and horse-driven coaches to steamers and railways, as well as the telegraph. Speed of information transmission has normally been measured by calculating the duration between writing and receiving a letter, or between an important event and the time when the news was published elsewhere. As overseas mail was generally carried by ships, the history of communications and maritime history are closely related. This study also brings a postal historical aspect to the academic discussion. Additionally, there is another new aspect included. In business enterprises, information flows generally consisted of multiple transactions. Although fast one-way information was often crucial, e.g. news of a changing market situation, at least equally important was that there was a possibility to react rapidly. To examine the development of business information transmission, the duration of mail transport has been measured by a systematic and commensurable method, using consecutive information circles per year as the principal tool for measurement. The study covers a period of six decades, several of the world's most important trade routes and different mail-carrying systems operated by merchant ships, sailing packets and several nations' steamship services. The main sources have been the sailing data of mail-carrying ships and correspondence of several merchant houses in England. As the world's main trade routes had their specific historical backgrounds with different businesses, interests and needs, the systems for information transmission did not develop similarly or simultaneously. It was a process lasting several decades, initiated by the idea of organizing sailings in a regular line system. The evolution proceeded generally as follows: originally there was a more or less irregular system, then a regular system and finally a more frequent regular system of mail services. The trend was from sail to steam, but both these means of communication improved following the same scheme. Faster sailings alone did not radically improve the number of consecutive information circles per year, if the communication was not frequent enough. Neither did improved frequency advance the information circulation if the trip was very long or if the sailings were overlapping instead of complementing each other. The speed of information transmission could be improved by speeding up the voyage itself (technological improvements, minimizing the waiting time at ports of call, etc.) but especially by organizing sailings so that the recipients had the possibility to reply to arriving mails without unnecessary delay. It took two to three decades before the mail-carrying shipping companies were able to organize their sailings in an optimal way. Strategic shortcuts over isthmuses (e.g. Panama, Suez) together with the cooperation between steamships and railways enabled the most effective improvements in global communications before the introduction of the telegraph.

Poetics of Subjectivity : Existence and Expressivity in Simone de Beauvoir's Philosophy

In the last thirty years, primarily feminist scholars have drawn attention to and re-evaluated the philosophy of Simone de Beauvoir (1908 1986). Her philosophical practice has been described as non-systematic, and her literary writing has been viewed as part of her non-systematic mode of philosophising. This dissertation radically deepens the question concerning Beauvoir s philosophical motivations for turning to literature as a mode to express subjectivity. It explicates the central concepts of Beauvoir s philosophy of existence, which are subjectivity, ambiguity, paradox and temporality, and their background in the modern traditions of existential philosophy and phenomenology. It also clarifies Beauvoir s main reason to turn to literature in order to express subjectivity as both singular and universal: as a specific mode of communication, literature is able to make the universality of existence manifest in the concrete, singular and temporal texture of life. In addition, the thesis gives examples of how Beauvoir s literary works contribute to an understanding of the complexity of subjectivity. I use the expression poetics of subjectivity to refer to the systematic relation between Beauvoir s existential and phenomenological notion of subjectivity and her literary works, and to her articulations of a creative mode of using language, especially in the novel. The thesis is divided into five chapters, of which the first three investigate Beauvoir s philosophy of existence at the intersection of the modern traditions of thought that began with René Descartes and Søren Kierkegaard s intuitions about subjectivity. Chapter 1 interprets Beauvoir s notion of ambiguity, as compared to paradox, and argues that both determine her notion of existence. Chapters 2 and 3 investigate the phenomenological side of Beauvoir s philosophy through a study of her response to early French interpretations of transcendental subjectivity, especially in the works of Jean-Paul Sartre and Maurice Merleau-Ponty. My analysis shows that Edmund Husserl s distinction between different levels of subjective experience is central to Beauvoir s understanding of subjectivity and to the different ego concepts she uses. Chapter 4 is a study of Beauvoir s reflections on the expression of subjective thought, and, more specifically, her philosophical conceptions of the metaphysical novel and the autobiography as two modes of indirect communication. Chapter 5, finally, compares two modes of investigating concrete subjectivity; Beauvoir s conceptual study of femininity in Le deuxième sexe and her literary expression of subjectivity in the novel L Invitée. My analysis reveals and explicates Beauvoir s original contribution to a comprehensive understanding of the becoming and paradox of human existence: the fundamental insight that these phenomena are sexed, historically as well as imaginatively.

Healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions: A qualitative systematic review protocol

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users’ experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, “healthcare users” will be taken to include children who have life-limiting conditions and their families. The question to be addressed is: - What are healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions? INCLUSION CRITERIA - Types of participants: This review will consider all qualitative studies that focus on users of healthcare services for children who have life-limiting conditions. These users are anticipated to include children who have a life-limiting condition and their family members. In instances where children are not under the legal care of one or both parents, service users may also include other types of legal guardians. - Phenomena of interest: This review will consider experiences of communicating with healthcare professionals about children who have life-limiting conditions. - Context: This review will consider studies relating to communication with healthcare professionals about children who have a life-limiting condition, irrespective of whether the healthcare service is based in a hospital, hospice, or community setting. There is no restriction on the country in which a study was conducted.

From garamut to mobile phone: Communication change in rural Papua New Guinea

This article presents the attitudinal response of rural villagers in Papua New Guinea to mobile telephony, based on a threshold study made during the early stages of its adoption. The research indicates that the introduction of mobile telecommunications has generally been viewed positively, with mobile phones affording social interaction with loved ones. Nonetheless, negative concerns have been strongly felt, notably financial costs and anxiety about mobile phones aiding in the coordination of extramarital liaisons and criminal activities. The communities investigated previously had scant access to modern communication technologies, some still using traditional means such as wooden slit drums, known locally as garamuts. The expansion of mobile network coverage has introduced into communal village life the capability to communicate dyadically and privately at a distance. Investigation into the adoption of mobile phones thus promotes understanding about traditional means of communication and notions of public and private interactions.

Framing as status or benefits? Consumers’ reactions to hierarchical loyalty program communication

Purpose A fundamental aspect of hierarchical loyalty programs is that some consumers get rewards that others do not. Despite the widespread use of such programs, academics have long debated whether these benefits are outweighed by the potential negative impact of the differential treatment of customers. This study extends our understanding, examining the impact of message framing on consumers’ reactions to hierarchical loyalty structures. Design/methodology/approach Three online studies were conducted. Study 1 uses advertisements to manipulate the message frame’s emphasis (benefits vs. status). Study 2 manipulates consumers’ frame of thought by directing their attention to either changes in benefits or status. Finally, Study 3 uses the proposed framework to reconcile contradictory findings from past research. Findings Low-frequency customers who do not expect to qualify for a superior customer tier tend to reject hierarchical programs when thinking about status. In contrast, when these customers think about concrete rewards, loyalty program messages produce no negative reactions. High-frequency customers are positively affected by communication regardless of the type of benefits framed. Research limitations/implications All studies were done online potentially limiting the external validity of the results. Nevertheless, the impact of message framing on perceptions about the loyalty program seems to be quite robust across different studies and manipulations. Practical implications When communicating with low-frequency customers managers should avoid promising status; customers should instead be motivated based on concrete rewards. High-frequency customers are indifferent to alternative emphasis of communication frames. Originality/value Marketing academics have acknowledged the importance of being able to reward top customers without demotivating light and moderate users. Our research is the first to provide a solution to this issue.

The Temporal Landscape of Residential Aged Care Facilities – Implications for Context-Sensitive Health Technology

Health information technology (IT) can have a profound effect on the temporal flow and organisation of work. Yet research into the context, meaning and significance of temporal factors remains limited, most likely because of its complexity. This study outlines the role of communications in the context of the temporal and organizational landscape of seven Australian residential aged care facilities displaying a range of information exchange practices and health IT capacity. The study used qualitative and observational methods to identify temporal factors associated with internal and external modes of communication across the facilities and to explore the use of artifacts. The study concludes with a depiction of the temporal landscape of residential aged care particularly in regards to the way that work is allocated, prioritized, sequenced and coordinated. We argue that the temporal landscape involves key context-sensitive factors that are critical to understanding the way that humans accommodate to, and deal with health technologies, and which are therefore important for the delivery of safe and effective care.

Interactive Distributed Source Coding in Asymmetric Communication Scenarios

We provide a new unified framework, called "multiple correlated informants - single recipient" communication, to address the variations of the traditional Distributed Source Coding (DSC) problem. Different combinations of the assumptions about the communication scenarios and the objectives of communication result in different variations of the DSC problem. For each of these variations, the complexities of communication and computation of the optimal solution is determined by the combination of the underlying assumptions. In the proposed framework, we address the asymmetric, interactive, and lossless variant of the DSC problem, with various objectives of communication and provide optimal solutions for those. Also, we consider both, the worst-case and average-case scenarios.

Software Pipelined Execution of Stream Programs on GPUs

The StreamIt programming model has been proposed to exploit parallelism in streaming applications on general purpose multi-core architectures. This model allows programmers to specify the structure of a program as a set of filters that act upon data, and a set of communication channels between them. The StreamIt graphs describe task, data and pipeline parallelism which can be exploited on modern Graphics Processing Units (GPUs), as they support abundant parallelism in hardware. In this paper, we describe the challenges in mapping StreamIt to GPUs and propose an efficient technique to software pipeline the execution of stream programs on GPUs. We formulate this problem - both scheduling and assignment of filters to processors - as an efficient Integer Linear Program (ILP), which is then solved using ILP solvers. We also describe a novel buffer layout technique for GPUs which facilitates exploiting the high memory bandwidth available in GPUs. The proposed scheduling utilizes both the scalar units in GPU, to exploit data parallelism, and multiprocessors, to exploit task and pipelin parallelism. Further it takes into consideration the synchronization and bandwidth limitations of GPUs, and yields speedups between 1.87X and 36.83X over a single threaded CPU.